New Delhi, 16 August 2025: Kala-azar, also known as visceral leishmaniasis, is a life-threatening parasitic disease that silently wreaks havoc in several regions of India—most notably Bihar, Jharkhand, West Bengal, and parts of Uttar Pradesh. Caused by the Leishmania donovani parasite and transmitted via the bite of infected sandflies, this disease attacks the body’s internal organs—particularly the liver, spleen, and bone marrow. Let’s unravel what makes kala-azar so deadly, and how communities and authorities are fighting back.
What Is Kala-Azar and How Does It Spread?
Kala-azar—literally “black fever”—is among the world’s most lethal parasitic diseases. The sandfly Phlebotomus argentipes transmits the Leishmania donovani parasite when it bites humans. Once inside, the parasite multiplies in organs such as the liver and spleen, compromising immune function and triggering life-threatening symptoms.
While historically prevalent in eastern and central India, cases have plummeted in recent years thanks to aggressive elimination campaigns. Still, areas steeped in poverty, malnutrition, and poor sanitation remain vulnerable to outbreaks.
The disease is endemic to 633 blocks across four Indian states—Bihar, Jharkhand, West Bengal, and Uttar Pradesh—and accounts for the vast majority of national cases. While rare cases have surfaced in areas like Madhya Pradesh, Kerala, and Assam, the core burden remains firmly in the east.
Kala-azar most often surges between June and October, during the late monsoon and early post-monsoon period. Rising humidity, stagnant water, and muddy environments create ideal breeding grounds for sandflies, increasing the risk of disease spread.
Recognizing the Telltale Symptoms
Kala-azar may begin subtly, but the warning signs grow more severe over time. Key symptoms include:
- Prolonged high fevers, often irregular and unresponsive to standard medications
- Rapid, unexplained weight loss
- Profound fatigue and weakness
- Severe anemia, leading to pallor and lethargy
- Enlarged liver and spleen, detectable through swelling in the abdomen
- Skin darkening—a signature sign, giving the disease its nickname
- Loss of appetite and slow growth in children
Left untreated, this often proves fatal within two years, marking kala-azar as a silent but deadly nemesis.
Treatment: From Hospital Care to Home Support
Thanks to medical advancements, kala-azar is treatable—but only with proper care. The main treatments include:
- Liposomal Amphotericin B, delivered via hospital supervision, is highly effective and minimizes toxicity.
- Miltefosine, an oral medication now part of national treatment protocols.
- Oral and injectable combination therapies (e.g., with paromomycin) offer over 97% cure rates.
Complementing treatment, proper nutrition and hydration are critical—nutrition supplements like pulses and multivitamins are often provided to bolster recovery.
India’s Push Toward Elimination
India’s multi-faceted elimination strategy has achieved remarkable results. Between 2014 and 2022, cases dropped by around 98%—with more than 630 out of 633 endemic blocks meeting elimination criteria. Success comes from:
- Aggressive case detection—screening entire villages after identifying a case.
- Indoor residual spraying (IRS) of insecticide to reduce sandfly populations.
- Real-time information systems to track cases and allocate resources quickly.
- Wage-loss compensation to incentivize treatment-seeking.
Despite near-elimination status, early detection, sustainable spray coverage, and surveillance remain essential to preventing resurgence.
The Socioeconomic Toll: Who Bears the Burden?
Kala-azar is the “disease of the poor,” striking hardest in marginalized rural communities with poor housing, malnutrition, and limited access to healthcare. In hard-hit regions, families spend significant resources on treatment—even taking loans with exorbitant interest. For some, the financial burden persists long after recovery.
Innovations in Surveillance and Treatment
To maintain elimination gains, several innovative strategies are in play:
- Telehealth solutions, including real-time surveillance and remote care, bridge gaps in remote areas.
- Targeted elimination campaigns, such as active case detection in hotspot villages.
- Policies to prevent relapse in vulnerable groups like malnourished patients or those co-infected with HIV.
These tools help ensure timely diagnoses and equitable access to lifesaving treatments.
Overcoming Remaining Challenges
Despite incredible progress, Kala-azar still poses challenges:
- Drug resistance, including to older treatments like sodium antimony gluconate.
- Insecticide resistance in sandfly populations in some areas.
- Post-treatment skin conditions like PKDL, which can sustain transmission.
- The absence of an effective vaccine.
Sustainable elimination will depend on community engagement, monitoring, and keeping vigilance even when numbers are low.
Community Protection Through Prevention
Prevention remains the most powerful tool. Simple yet effective measures include:
- Maintaining clean and dry surroundings, free of pits and standing water.
- Using insecticide-treated bed nets and full-coverage clothing.
- Indoor residual spraying, especially on walls and dark spaces where sandflies hide.
- Prompt treatment of infected individuals to prevent wider spread.
Prevention helps safeguard entire communities—not just individuals.
Kala-azar once haunted rural India relentlessly; today, the path to eradication is within sight. Thanks to sustained investment in prevention, surveillance, and treatment innovations, India is nearing elimination as a public health concern.
But true victory means more than a statistic—it means lasting safety, equitable healthcare access, and resilient health systems.
